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Clinical and Operational Research Questions for Collaborative Care
There is currently limited knowledge about the penetration and composition of collaborative care. There is now a way of assigning model specificity to individual sites. It is agreed that the lack of a consistent evaluation model or specified outcomes has impeded large-scale translational opportunities. The following questions reflect the need to respond to these issues:
- What is currently occurring in collaborative care practices nationally?
- Who is being seen and what are the descriptors of the patients and integrated practices?
- What is the distribution of practices along a continuum of integration/collaboration? (Table 1)
- Do practice progress along this continuum? If so, what does the timeline look like (how long to evolve services to higher or lower levels?)
- Does progression along a continuum of integration produce better outcomes in:
- Successful referrals to other healthcare providers (patients show up for their scheduled appointments)?
- Patients in each category of mental health range of need (Table 1)?
- Psychosocial Determinants of Health
- Medical Presentations Which Need Behavioral Treatment
- Comorbid Medical and Psychological Presentations
- Identification and Treatment of Mental Health and Substance Abuse
- Severe Mental Health/ Substance Abuse Management
- What is the distribution of current practice models?
- What is the distribution of professional degrees among clinicians working in integrated models?
- Who is being seen and what are the descriptors of the patients and integrated practices?
- What is the patient perspective of the purpose content and utility of collaborative care practices?
- Profile practices according to the parameters of the paradigm case formulation (Table 4), but at a more detailed level taking into account model specific information and operational components. Results from these profiles will provide the initial basis for a scale of “collaborativeness”.
- Do differences in the level of “collaboration” have an impact on clinical, operational and financial outcomes?
- How does the level of communication between mental health and primary care provider’s impact clinical care?
- What dimensions of collaborative care have the greatest effect on outcomes?
- How do CCRN practices compare to other collaborative care practices across the country?
- How can organizational and financial dimensions be operationalized and become part of the overarching evaluation model?
- Establish an evaluation model that includes metrics for access, identification and treatment
- Establish a national data base of collaborative care practices assuring representation from practices in a broad range of practice conditions to assure that underrepresented pratice and patient types are included in analyses.
- Little is known about the resources available for integrating primary care and specialty mental health care for persons with severe and persistent mental illness. Many of the questions listed above also apply to settings where primary care is integrated into mental health.
- What role does the delivery setting [the parameter—primary medical setting, specialty medical setting, or specialty mental health setting] play on outcomes for patients with severe mental illness in a collaborative care model?
- Is improved patient access to mental health in primary care associated with
- Frequency of patient self-identification of mental health problems?
- Overall patient volume (% of panel)?
- The frequency of patients identified by practice?
- Frequency of patients referred to outpatient mental health change?
- Treatment initiation/completion and attendance rates?
Advancing Collaborative Care Research Conference
Clinical and Operational Research Questions for Collaborative Care
